Pancreaticoduodenectomy for biliary tract carcinoma with situs inversus totalis: difficulties and technical notes based on two cases

Abstract

Situs inversus totalis (SIT) denotes complete right-left inversion of the thoracic and abdominal viscera. Diagnosis and surgical procedures for abdominal pathology in patients with SIT are technically more complicated because of mirror-image transposition of the visceral organs. Moreover, SIT is commonly associated with cardiovascular and hepatobiliary malformations, which make hepatobiliary-pancreatic surgery difficult. Two cases of pancreaticoduodenectomy for biliary tract carcinoma in patients with SIT are presented. Both patients had an anomaly of the hepatic artery. Advanced diagnostic imaging techniques were very important for careful preoperative planning and to prevent misunderstanding of the arrangement of the abdominal viscera. This facilitated the surgical team’s adaptation to the mirror image of the standard procedure and helped avoid intraoperative complications due to cardiovascular and hepatobiliary malformations associated with SIT. Pancreaticoduodenectomy in patients with SIT can be performed successfully with detailed preoperative assessment, use of effective techniques by the surgeon, and appropriate support by assistants.

Risk Factors and Medico-Economic Effect of Pancreatic Fistula after Pancreaticoduodenectomy

“…The PD surgery with laparoscope has been clinically applied since its first description by Gagner and Pomp [ 33 ] in 1994 [ 34 , 35 ]. The multivariate analysis of 13 PD patients with laparoscope (PF: 10, CR-PF: 4) and 309 patients with laparotomy showed that more patients treated with laparoscope developed PF than that treated with laparotomy.…”

Chirurgie spiegelverkehrt

“…0,01% bzw. tritt bei einer von 8000-25.000 Lebendgeburten auf [3]. Der inkomplette oder partielle Situs inversus ist noch wesentlich seltener [6].…”

Origin of the Celiac and Superior Mesenteric Arteries in a Common Trunk - Description of a Rare Vessel Variation of the Celiacomesenteric Trunk with a Literature Review

“…With the development of imaging technology, such as computed tomography (CT), magnetic resonance imaging (MRI), and angiography methods, information regarding vessel variation has become very important. In addition, understanding of vessel variation in the celiac and superior mesenteric arteries is also useful for the surgical treatment and clinical examination of the supramesocolonic organs [16][17][18][19][20] . This report aimed at documenting vessel variation throughout the supramesocolonic organs to aid clinical treatment and examination.…”